软双相的早期诊断识别并文献复习  

Early diagnosis and literature review of soft bipolarity

作　　者：陈明辉 李功迎[1] Chen Minghui;Li Gongying(College of mental health,Jining Medical University,Jining 272067,China)

机构地区：[1]济宁医学院精神卫生学院,272067

出　　处：《中华诊断学电子杂志》2018年第4期256-259,共4页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：国家自然科学基金(81571334);山东省研究生教育创新计划项目(SDYY15012);山东省本科高校教学改革研究项目(2015M049)

摘　　要：目的探讨有转躁倾向的抑郁症(软双相)患者的人口学、症状学特征及其他相关因素,以早期诊断识别双相障碍。方法回顾性分析于2016年7月5日就诊于济宁市精神病防治院精神科,有转躁倾向并最终进展为双相情感障碍的1例抑郁症患者的临床资料,并复习相关文献。结果患者入院时表现为心烦、少语、情绪低落、兴趣下降,但该患者起病年龄小,家族史阳性,抑郁发作时心境波动性较大,且精神病性症状突出,伴有强烈自杀观念,不排除软双相可能。患者入院3 d便出现明显躁狂症状,遂修改诊断为"双相情感障碍",并调整治疗方案后很快达临床痊愈。结论对起病年龄小、家族史阳性、伴精神病性症状、自杀观念等特征的抑郁症患者应格外重视,警惕软双相可能,治疗上应以情感稳定剂为主,慎用抗抑郁剂。Objectives To investigate the demographic, symptomatic characteristics and other related factors of depression with mania tendency （soft bipolarity）, so as to diagnose and identify bipolar disorder early. Methods A retrospective analysis of the clinical data of one bipolar disorder patient with depression who eventually progressed to bipolar disorder and received treatment in psychiatry department of Jining Psychiatric Hospital on July 5, 2016, and the relevant literatures were reviewed. Results At admission, the patient showed upset, hypologia, depression and decreased interest. However, given that the young onset age, the positive family history, the mood swung greater during the onset of depression, and the psychotic symptoms were prominent with strong suicidal ideation, the possibility of soft bipolarity in this patient may not be eliminated. After 3 days of admission, the patient showed obvious manic symptoms, then the diagnosis was modified to “bipolar disorder” and clinical recovery was achieved soon after the treatment plan was adjusted. Conclusions Patients with depression of young onset age, positive family history, psychotic symptoms and suicidal ideation should be paid more attention to the possibility of soft bipolar. The mood stabilizers should be the main treatment, and the antidepressants should be of prudent use.

关 键 词：双相情感障碍 抑郁症 诊断 

分 类 号：R749.4[医药卫生—神经病学与精神病学]